JP4468165B2 - Organ retractor and method using the same - Google Patents

Description

(Citation of related application)
This application claims the benefit and priority of US Provisional Patent Application No. 60 / 379,378, filed May 9, 2002, the entire contents of which are hereby incorporated by reference. Incorporated.

(background)
(Technical field)
The present disclosure relates to devices and methods used to retract an organ during a surgical procedure, and more particularly to an endoscopic apparatus for retracting or positioning an organ during minimally invasive surgery. .

(Background of related technology)
As a result of recent technological advances in surgical instruments, surgical procedures that use minimally invasive techniques are routinely performed and the surgical procedures do not cause much trauma to the patient. Some minimally invasive surgical procedures have limitations due to their small inner diameter of many commonly used cannula and trocar systems. As a result, instrument manufacturers take advantage of the deformable frame opening to innovate to use many common instruments (eg, organ retractors and tissue retrieval bags) that fit the patient through the trocar. And find new and new solutions. In fact, some organ retractors and tissue retrieval bags use an inflatable frame, which forms a component used to manipulate tissue. An exemplary inflatable organ retraction device is disclosed in US Pat. No. 5,823,945 to Moll et al., The entire contents of which are hereby incorporated by reference.

  Consequently, an additional system for pressurizing the inflatable frame is needed. As can be appreciated, inflatable tissue retrieval devices tend to be vulnerable to accidental contractions in the operating room and, when the device is operated, to support the organ and / or to contain tissue Unnecessarily dependent on the stiffness of the inflatable structure. In addition, inflatable devices tend to be more complex and expensive than corresponding non-inflatable devices.

  There is a continuing need for an endoscopic device for retracting an organ that reduces the forces acting on the organ and allows for improved control of the organ.

(Summary)
The present disclosure relates to an endoscopic retractor device for retracting an organ during minimally invasive surgery. The apparatus includes an elongated shaft having a proximal end and a distal end and a lumen extending between the proximal and distal ends, a retractable sleeve operably coupled to the elongated shaft ( retracting sleeve). The retractable sleeve is a first spindle and a second spindle each positionable in the lumen of the elongated shaft, each spindle being selectively translatable through at least a portion of the lumen of the elongated shaft. A first spindle and a second spindle; and a sling portion extending between a distal end of the first spindle and a distal end of the second spindle, the hanging part Defines a cradle for receiving an organ therein, the hanging portion being selectively movable upon translation of at least one of the first and second spindles And a hanging portion.

  In certain preferred embodiments, the first spindle and the second spindle are integrally formed with the suspended portion.

  In certain embodiments, the endoscopic retractor device further comprises a control portion, a first spindle and a second spindle operably connected to the proximal end of each of the shafts. The control portion cooperates with the first and second spindles to allow a user to move the suspension portion remotely to engage the organ.

  The control portion desirably includes a locking mechanism for maintaining the suspended portion at a desired location relative to the retracting sleeve. The locking mechanism maintains the suspended portion in at least one of a deployed position and a contracted position.

  The endoscopic retractor device preferably has a first position in which the suspended portion of the retracting sleeve is at least partially held in the lumen of the elongated shaft, and the suspended portion of the retracting sleeve is A second position not retained in the lumen of the elongate shaft. When the device is in the second position, the suspended portion desirably defines a supporting area for engaging the organ.

  Preferably, the support area is in the form of an open loop. It is contemplated that the suspended portion is made from a material (eg, mesh, ribbon and / or cloth) that reduces the occurrence of ischemia in the organ when in contact with this portion. The suspended portion may comprise a saddle provided along the tissue contacting surface of the suspended portion to enhance the bearing force between the suspended portion and the organ.

  In certain embodiments, the suspended portion comprises a plurality of ports formed along the tissue contacting surface of the suspended portion. The suspension portion may be operably connected to a control portion, wherein the control portion is configured and adapted to deliver reduced pressure to at least some of the plurality of ports formed in the suspension portion. ing. The reduced pressure may be delivered to a portion of the plurality of ports through at least one of the first spindle and the second spindle.

  In certain embodiments, the endoscopic retractor device further comprises a cinch configured and adapted to clamp at least a portion of the suspended portion around the organ. The cinch is a substantially rigid annular structure. The cinch may be disposed around the first spindle and the second spindle. Therefore, when the cinch is removed from the distal ends of the first spindle and the second spindle in the direction in which the cinch is spaced apart, the suspended portion is tightened.

  In another embodiment, it is envisioned that the endoscopic retractor device further comprises a clamping mechanism configured and adapted to clamp at least a portion of the suspended portion around the organ. The The tightening mechanism includes an elongate tubular body that is reciprocally received in the lumen of the elongate shaft, and a loop extending from a distal end of the elongate tubular body, the loop defining an opening. Here the opening of the loop can be enlarged by releasing the loop from the tubular body, and the opening of the loop can be reduced by retracting the loop into the tubular body. The loop may be made from at least one of a suture and a wire. Thus, when the loop of the tightening mechanism is disposed between the suspended portion and the distal end of the spindle and the organ is placed within the suspended portion, the loop is inserted into the tubular body. By retracting, the suspension is tightened around the organ.

  In certain embodiments, the elongate shaft has a first section defining a lumen extending therethrough, wherein the first spindle is positionable in the lumen of the first section, and the first section A second section defining a lumen extending therethrough, wherein the second spindle is in this lumen of the second section And is selectively translatable through the lumen of this second section.

  The first section and the second section of the elongate shaft have a first position where the first section and the second section are in a vertical registration with each other, and the first section and the second section are perpendicular to each other. It has a second position that is out of line. It is envisioned that this first section is pivotally attached to the second section. Thus, when the first section and the second section move from the first position to the second position, the hanging portion opens, and the first section and the second section move from the second position. When moving to this first position, this hanging part is closed.

  Each of the first and second sections is fabricated from a shape memory alloy. Accordingly, the elongate shaft has a first arrangement in which the distal ends of the first section and the second section are in a vertical overlap with each other, and the distal ends of the first and second sections are in the body cavity After being introduced, it has a second arrangement laterally away from each other. In certain embodiments, the first section and the second section are biased toward the second configuration. The endoscopic retractor device further includes a sleeve positionable about the tubular shaft, wherein the elongate shaft is retracted from the second configuration to the first when the tubular shaft is retracted through the sleeve. Promoted to deployment.

  The endoscopic organ retractor disclosed herein, together with the attendant advantages, is best understood by referring to the following detailed description in conjunction with the following drawings.

Detailed Description of Preferred Embodiments
Preferred embodiments of the organ retractor disclosed herein will now be described in detail with reference to the drawings, wherein like reference numerals identify like or identical elements. In the drawings and the following description, the term “proximal” conventionally refers to the end of the surgical device or instrument of the present disclosure that is closest to the operator, while the term “distal” is the most from the operator. The far end of the device or instrument.

  Referring now to FIGS. 1-3, an endoscopic retractor device is generally designated as reference numeral 10, in accordance with the principles of the present disclosure. The retractor 10 is desirably configured and adapted to retract an organ (eg, liver, intestine, uterus or lung) during minimally invasive surgery. The retractor 10 is preferably designed for use with an endoscope and is selectively configurable to retract or manipulate organs and tissues within the surgical cavity. The retractor 10 includes a tubular shaft 20, a ribbon-like retracting sleeve or sling 40 that can be received in the tubular shaft 20. The retractor desirably includes a control portion 60 operably coupled to the tubular shaft 20 and the retracting sleeve 40.

  Tubular shaft 20 includes a distal end 22 and a proximal end 24 and defines a lumen 25 between the distal and proximal ends. The illustrated tubular shaft 20 has a substantially circular cross-sectional shape, but the tubular shaft 20 may have any shape. It is envisioned that the tubular shaft 20 is made from a generally rigid or relatively rigid material. As can be seen in FIG. 1, the proximal end 24 is connected to a control portion 60 that allows the surgeon to selectively manipulate the shaft 20 as needed during surgery. To do.

  The retracting sleeve 40 preferably includes a pair of elongated spindles 42 and 44, which pair of elongated spindles includes a suspended portion 46 that extends between the distal end of the spindle 42 and the distal end of the spindle 44. Having an elongated flexible material in form. As described in more detail below, when the retracting sleeve 40 is in the deployed position (ie, the suspended portion 46 extends out of the distal end 22 of the tubular shaft 20), the suspended portion 46 Defines a support region 47 (see FIG. 3) that extends between the distal end of spindle 42 and the distal end of spindle 44. Spindles 42 and 44 include proximal portions 43 and 45 that remotely manipulate suspended portion 46 so that a user retracts organ 200 (see FIG. 2). Make it possible. Specifically, the spindles 42 and 44 may be constructed from rods, sutures, or wires that are attached to the control portion 60 and allow the user to remotely hang the suspended portion 46 around the organ 200. It is possible to orient. More specifically, the spindles 42 and 44 are constructed from a material suitable for sliding into the tubular shaft 20. In certain embodiments, these spindles are integrally formed with the suspended portion 46. Preferably, the suspended portion 46 is configured and adapted to gently support the organ 200 during retraction. The suspended portion 46 is desirably fabricated from a mesh, ribbon or other fabric-type material, or combination of materials (preferably having properties to reduce the occurrence of ischemia in the organ 200 during retraction). Is done. The suspended portion 46, spindles 42 and 44, and shaft 20 are desirably formed from medical grade material.

  Preferably, the suspended portion 46 forms an open loop (i.e., support region 47) when the retracting sleeve 40 is in the deployed position, which easily grasps the organ 200 for retraction. . The suspended portion 46 preferably has a generally flat shape when left open, but may be shaped differently depending on the particular purpose (eg, to lift a particular organ). Good. For example, the suspended portion 46 may have a concave or trough-like configuration (see FIG. 2), a conical shape, or a loop-like shape to fit dimensions close to a particular organ. As can be appreciated, the different contour configurations of the suspended portion 46 may provide a more uniform surface for capturing and retracting the organ 200 therein. In certain embodiments, the width of this suspended portion varies with its length.

  This suspended portion 46 is desirably manipulated by retracting or advancing one or more spindles through the shaft 20. Advancement of one or both of the spindles loosens this suspension part and allows the operator to loop the suspension part around the organ to be retracted or supported. After engaging the organ in the suspension part, one or both of the spindles are retracted through the shaft 20 to close the suspension part around the organ.

  As can be seen in FIG. 1, the control portion 60 may be configured with a locking mechanism 65 (eg, cam lock, suture lock, or any known mechanism) to maintain the suspended portion 46 in the desired position during retraction. Can be provided. In certain embodiments, the locking mechanism 65 includes a rotatable latch to frictionally engage and secure one or more of the spindles 42, 44. In other embodiments, the locking mechanism 65 cooperates with the housing of the control portion and comprises a deformable member to engage one or more of the spindles. The deformable member is desirably disposed with a cam on the housing to propel the deformable member inward. The slide portion that the operator can contact can be connected to the deformable member to slide the deformable member with respect to the cam on the housing. When the slide portion is advanced in one of the proximal or distal directions, the deformable member deforms inward to frictionally engage and secure the spindle. In a further embodiment, the locking mechanism 65 comprises a slider having one or more fixed positions with respect to the housing at the proximal end of the shaft 20. In a further embodiment, the spindle can be tied to a cleat at the proximal end of the shaft 20 to fix the position of the spindle.

  In certain embodiments, the retracting force applied to the retracting sleeve 40 to retract the retracting sleeve 40 through the tubular shaft 20 can be manually sensed by the operator during operation of the organ 200 or alternatively In addition, the control portion 60 is configured and adapted to detect the amount of retracting force applied to the retracting sleeve 40 having the organ 200 in the suspended portion 46 to retract the retracting sleeve 40 through the tubular shaft 20. One or more sensors may be provided. In other embodiments, the suspended portion may include a sensor for sensing forces applied to the organ and / or detecting loss of support for the organ.

  The suspended portion 46 of the retractable sleeve 40 may also be provided with a friction enhancing texture or brace 62 that supports the carrier force between the suspended portion 46 and the organ 200 and / or during its operation. In order to enhance the degree of friction, it is provided along the inner surface (ie, tissue contacting surface) of the suspended portion 46. In certain embodiments, the suspended portion 46 of the retractable sleeve 40 can be provided with a plurality of suction ports 64 formed on its entire inner surface (ie, the tissue contacting surface). Accordingly, when reduced pressure is applied to the suction port 64, the suspended portion 46 attaches itself at least partially to the organ 200, thereby allowing the operator to handle and / or manipulate the organ 200 during retraction. Increase ability. Desirably, each suction port 64 is in fluid communication with a reduced pressure source 67 that is connected to the control portion via a network of lumens (not shown) extending between the suction port 64 and the reduced pressure source 67. 60 (see FIG. 1). It is contemplated that the lumen network is configured and dimensioned to extend through at least one of the spindles 42 and 44.

  In use, the retractor 10 is moved from a first position (where the spindles 42 and 44 of the retracting sleeve 40 are substantially completely disposed within the tubular shaft 20) to a second position (here suspended). The lowered portion 46 is movable to an open or deployed position. More specifically, the operator uses the control unit 60 to manipulate the spindles 42, 44 and move the hanging portion 46 under the organ 200 (ie, open / close). When the organ 200 is placed in the suspended portion 46, the spindles 42, 44 are retracted into the shaft 20 to wrap, capture and retract the organ 200. Preferably, the surgeon can sense the amount of pressure applied to the organ 200 during retraction. The locking mechanism 65 is then preferably actuated to fix the position of the spindles 42, 44 and fix the organ 200 in the retracted position.

  At the end of the surgical procedure or any portion thereof, the locking mechanism 65 is released and the organ 200 is returned to its original, prior to retracted position. The retractor 10 is then retracted through the trocar assembly.

  A further embodiment of the invention is shown in FIG. 4A. The cinch for the retractor 10 is generally indicated as 351. The cinch 351 is constructed and adapted to surround at least a portion of the spindles 42, 44 and the suspended portion 46. It is envisioned that the cinch 351 is a loop-like structure, preferably a rigid annular ring, preferably made from steel, plastic, etc., to facilitate positioning of the cinch 351 along the spindles 42,44. . In use, the cinch 351 is advanced distally over and below the distal end of the spindles 42, 44 over the suspended portion 46, with the suspended portion 46 disposed therein. / Close and / or tighten remotely around the tissue. The cinch 351 may or may not be attached to the shaft 20 or to one or more of the spindles 42,44.

  In another embodiment of the invention shown in FIG. 4B, the tightening mechanism for the retractor 10 is shown generally as 355. The fastening mechanism 353 is configured and adapted to surround at least a portion of the spindles 42, 44 and the suspended portion 46. The tightening mechanism 353 includes an elongate tubular body 355 that is translatably received in the lumen of the retractable sleeve 340 and an adjustable loop 357 extending from the tubular body 355 and defining an opening 359. It is contemplated that the loop 357 is made from sutures and / or wires 361. Thus, the opening 359 of the loop 357 can be expanded by releasing the wire 361 from the tubular body 355 and / or supplying more of this wire 361 and retracting the wire 361 into the tubular body 355. Can be tightened by. In use, when the organ / tissue 200 is placed in the suspended portion 46 and the wire 361 is placed around the suspended portion 46, the wire 361 in the loop 357 is retracted (ie, the opening 359 in the loop 357). Are preferably retracted around the region of the suspended portion 46 between the organ 200 and the distal ends of the spindles 42, 44, so that the suspended portion 46 is Closed around and / or tightened. The loop 357 of the tightening mechanism 353 is provided between the organ 200 and the distal ends of the spindles 42, 44 either before or after the organ 200 is placed on the suspension part 46. It can be placed in a surrounding position. The tightening mechanism 353 can be operably connected to the control portion 60 so that the tightening mechanism 353 can be remotely operated by the operator.

  In a further embodiment of the invention, as shown in FIGS. 5A and 5B, the endoscopic retractor device is generally designated as 400. The retractor 400 includes a tubular shaft 420 having a first section 421 and a second section 431. In certain embodiments, each of the first section 421 and the second section 431 is substantially semi-circular in shape, so that the first section 421 and the second section 431 are in a vertical overlap with each other. The first section 421 and the second section 431 have a substantially circular cross-sectional profile. Each section 421, 431 includes a lumen 425, 435, respectively, which extends through each section. The retractor 400 includes a retracting sleeve 440 having a first spindle 442 and a second spindle 444 (these spindles are disposed in the respective first section 421 and second section 431), and the distal end of the spindle 442. And a suspended portion 446 extending between the distal end of the spindle 444. Preferably, sections 421, 431 and spindles 442, 444 can be remotely operated by an operator.

  The tubular shaft 420 has a first position (see FIG. 5A) in which the first section 421 and the second section 431 are in a vertical overlap with each other, and the first section 421 and the second section 431 are in a vertical overlap with each other. A plurality of second positions (see FIG. 5B) that are out of position. Preferably, the distal ends of the first section 421 and the second section 431 are moved relative to each other in the direction indicated by arrow “B” to each of the first position and the second position. The first section 421 and the second section 431 can be separated and brought close together. Having separate movable first and second sections 421 and 431 allows the first and second sections 421 and 431 and then the spindles 442 and 444 to move relative to each other, thus organ 200. It is envisioned that the mechanical performance of the suspended portion 426 will be increased by facilitating the operation of

  In certain embodiments, each section 421, 431 of tubular shaft 420 is fabricated from a shape memory material (eg, shape memory alloy NITANOL). In this way, the sections 421, 431 are deployed sideways with respect to each other when the sections 421, 431 are exposed to a body cavity with a first arrangement in which the sections 421, 431 are in longitudinal overlap with each other. Can be fabricated to have a second arrangement spaced apart. A sleeve or cannula 440 may be provided around the proximal end of the sections 421, 431 to slide the distal ends of the sections 421, 431 back to their first configuration. Thus, by holding the sleeve 440 stationary, retraction of the sections 421, 431 through the sleeve 440 propels the distal end of the sections 421, 431 from the second configuration to the first configuration. Let In certain embodiments, the first section 421 and the second section 431 are biased to the second arrangement. The device may include a biasing structure between the first section 421 and the second section 431, or the first section 421 and the second section 431 are made from a material that is biased to the second arrangement. obtain.

  In operation, when the first section 421 and the second section 431 are in a vertical overlap with each other (ie, the tubular shaft 420 has a shallow profile), the tubular shaft 420 is inserted into the surgical site and the sleeve 420 is inserted into the spindle. 442, 444 is deployed by extending distally from the lumens 425, 435 of the first section 421 and the second section 431, and the distal ends of the first section 421 and the second section 431 are in the direction "B" To unfold and / or open the suspended portion 426. Once the organ 200 is placed in the suspended portion 426, the distal ends of the first half section 421 and the second half section 431 are brought closer together, thereby causing the organ 200 in the suspended portion 426 to move. Enclose.

  Preferably, the tubular shaft 420 is inserted into the body cavity so that the pivot point between the first section 421 and the second section 431 is as close as possible to the entrance to the body cavity. In this way, the distal ends of the first section 421 and the second section 431 are provided with a maximum range of motion and a minimal amount of stress is caused at the entrance to the body cavity.

  Alternatively, sections 421, 431 of tubular shaft 420 are made from shape memory alloy, sleeve or cannula 440 is inserted into the body cavity, and the distal ends of sections 421, 431 of tubular shaft 420 are in the first configuration. , The tubular shaft 420 is inserted through the sleeve 440 into the body cavity so that the distal ends of the sections 421, 431 are exposed to the body cavity, thereby displacing the distal ends of the sections 421, 431. Expand to the second configuration. When the surgical procedure is complete, the tubular shaft 420 is retracted through the sleeve 440, thereby driving the distal ends of the sections 421, 431 from the second configuration to the first configuration.

  While exemplary embodiments of the present disclosure have been described herein, the disclosure is not limited to those embodiments and various other changes and modifications can be made within the scope and spirit of the present disclosure. It should be understood that it can be provided by those skilled in the art without departing from the invention. All such changes and modifications are intended to be included within the scope of this disclosure.

The accompanying drawings are incorporated in and constitute a part of this specification, exemplify embodiments of the present disclosure, and together with the detailed description of the embodiments provided below, this disclosure Works to explain the principle of.
FIG. 1 is a perspective view of an endoscope retractor device according to an embodiment of the present invention. FIG. 2 is an enlarged perspective view of the endoscope retractor device according to the embodiment of FIG. 3 is an enlarged perspective view of the endoscopic retractor device according to the embodiment of FIGS. 1-2 in the region indicated by “3” in FIG. FIG. 4A is a perspective view of an endoscopic retractor device according to a further embodiment of the present invention. FIG. 4B is a perspective view of an endoscopic retractor device according to another embodiment. FIG. 5A is a perspective view of an endoscopic retractor device according to another embodiment of the present invention. FIG. 5B is a perspective view of an endoscopic retractor device according to the embodiment of FIG. 5A.

Claims (18)

An endoscopic retractor device for retracting an organ during minimally invasive surgery ,
The proximal end portion, an elongated shaft having a lumen extending between a distal end and a proximal end portion and said distal end,
Includes a retracting sleeve operatively coupled to the elongated shaft, the,
The wound sleeve is
A first spindle and second spindles each positionable in said lumen of the elongated shaft, the first spindle the a elongated through at least a portion of the lumen of the shaft selectively translatable and second A spindle ,
The extending between the first distal end of the spindle and the second distal end of the spindle, meshes, a suspended part which is fabricated from one of the ribbons and fabrics, organs therein the defining a cradle for supporting, and at least one of selectively movable der Ru hanging part during the translation of said first spindle and second spindle,
The retracting sleeve includes a first retracted position in which the first and second spindles are disposed in the lumen, and a second in which distal ends of the first and second spindles are deployed from the lumen. Take the unfolded position,
An endoscopic retractor device characterized by that . A control portion operably connected to a proximal end of each of the elongate shaft , the first spindle, and the second spindle;
The control portion cooperates with the first and second spindles to allow a user to move the suspension portion remotely to engage the organ.
The endoscope retractor device according to claim 1 . The control portion comprises a locking mechanism for maintaining the suspended portion in a desired location relative to the retracting sleeve;
The endoscope retractor device according to claim 2. The locking mechanism maintains the suspended portion in at least one of a deployed position and a retracted position;
The endoscope retractor device according to claim 3 . A first position in which the suspended portion of the retracting sleeve is at least partially retained in the lumen of the elongated shaft; and a second position in which the suspended portion of the retractable sleeve is not retained in the lumen of the elongated shaft. Take position,
The endoscope retractor device according to claim 1. When the endoscopic retractor device is in the second position, the suspended portion defines a support area that encloses the organ;
The endoscope retractor device according to claim 5. The suspended portion includes a rib that is provided along a tissue contact surface of the suspended portion and enhances a gripping force between the suspended portion and the organ .
The endoscope retractor device according to claim 1. The suspended portion comprises a plurality of ports formed along the tissue contacting surface of the suspended portion;
At least one member of the port is in fluid communication with a vacuum source;
The endoscope retractor device according to claim 1 . The hanging portion is operably connected to a control portion, and the control portion is configured to depressurize the portions of the plurality of ports formed in the hanging portion.
The endoscope retractor device according to claim 8. The part of the plurality of ports is depressurized via at least one of the first spindle and the second spindle.
The endoscope retractor device according to claim 9 . The apparatus further comprises a cinch configured and adapted to clamp at least a portion of the suspended portion around the organ.
The endoscope retractor device according to claim 1 . The cinch is a rigid annular structure,
The endoscope retractor device according to claim 11. The cinch is disposed around the first spindle and the second spindle;
The endoscope retractor device according to claim 12. When the first said cinch a direction in which the cinch from the distal end of the spindle and the second spindle are spaced apart is Ru is displaced, the hanging portion is tightened,
The endoscope retractor device according to claim 13. Further comprising a clamping mechanism configured to clamp at least a portion of the suspended portion around the organ;
The tightening mechanism is
An elongate tubular body removably received in the lumen of the elongate shaft;
A loop extending from a distal end of the elongated tubular body,
The loop defines an opening, the opening of the loop being expandable by releasing the loop from the elongated tubular body, the opening of the loop being reduced by retracting the loop into the elongated tubular body Is possible,
The endoscope retractor device according to claim 1. The loop is fabricated from at least one of a suture and a wire;
The endoscope retractor device according to claim 15. A loop of the clamping mechanism is positioned between the suspended portion and the distal end of the spindle, and retracts the loop into the elongated tubular body when the organ is placed in the suspended portion. The suspension part is tightened around the organ,
The endoscope retractor device according to claim 16. It said first spindle and said second spindle, Ru said the hanging portion integrally formed Tei,
The apparatus of claim 1.

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